Upload
others
View
8
Download
0
Embed Size (px)
Citation preview
Gluteal RegionGluteal Region- Today- Today’’s Dissection -s Dissection -
Unit 2, p35Unit 2, p35
Gluteal RegionGluteal Region- A Practical Lesson -- A Practical Lesson -
•• Reflect Reflect ONLYONLY the gluteus the gluteus
maximus m.maximus m.
•• To reveal theTo reveal the
ischioanal triangleischioanal triangle
•• Do Do NOTNOT dissect dissect
•• Deeper than theDeeper than the
sacro-spinous andsacro-spinous and
-tuberous ligaments-tuberous ligaments
•• Lateral to the sciaticLateral to the sciatic
nervenerve
Unit 2, p35Unit 2, p35
PerineumPerineum
- Today- Today’’s Word & Intellectual Challenge -s Word & Intellectual Challenge -
•• The region that closes the pelvic outletThe region that closes the pelvic outlet
•• Divided into two spaces (triangles)Divided into two spaces (triangles)
•• Ischioanal (Anal) triangleIschioanal (Anal) triangle
•• Urogenital (UG) triangleUrogenital (UG) triangle
•• Means Means ““modest or privatemodest or private””
Unit 2, p35Unit 2, p35
Abdominopelvic RegionAbdominopelvic Region
PerineumPerineum
PerinealPerineal Triangles (2) Triangles (2)
Unit 2, p35Unit 2, p35
PerinealPerineal
RecessesRecesses
Unit 2, p36Unit 2, p36
PerinealPerineal Vasculature Vasculature
Unit 2, p37Unit 2, p37
Ischioanal (Anal) TriangleIschioanal (Anal) Triangle
•• Divided into two lateral fossae by theDivided into two lateral fossae by the
rectumrectum
•• BoundariesBoundaries
•• Lateral: Sacrotuberous ligamentsLateral: Sacrotuberous ligaments
•• Posterior: CoccyxPosterior: Coccyx
•• Anterior: Perineal body (muscle)Anterior: Perineal body (muscle)
•• Superior (roof): Pelvic diaphragmSuperior (roof): Pelvic diaphragm
•• Inferior (floor): SkinInferior (floor): Skin
LandmarksLandmarks
SacrotuberousSacrotuberous
ligamentligament
ContentsContents
•• Levator ani muscleLevator ani muscle
•• Ischioanal fat padIschioanal fat pad
•• Pudendal (AlcockPudendal (Alcock’’s) canals) canal
•• Pudendal neurovascular bundle andPudendal neurovascular bundle and
their peripheral branchestheir peripheral branches
•• Anococcygeal (perineal) bodyAnococcygeal (perineal) body
•• Convergence of musclesConvergence of muscles
•• Rectum and anusRectum and anus
Inferior Rectal NervesInferior Rectal Nerves
VasculatureVasculature
Pudendal CanalPudendal Canal
Central Tendon of the PerineumCentral Tendon of the Perineum- Perineal Body -- Perineal Body -
•• Area of fusion among theArea of fusion among the
•• Posterior margin of the UG diaphragmPosterior margin of the UG diaphragm
•• Perineal fasciaPerineal fascia
•• Pelvic diaphragmPelvic diaphragm
•• External anal sphincterExternal anal sphincter
•• Same in males and femalesSame in males and females
•• In females, fusion is more extensive and theIn females, fusion is more extensive and the
fused tissue is yellow fibroelastic connectivefused tissue is yellow fibroelastic connective
tissuetissue
Perineal BodyPerineal Body
Unit 2, p37Unit 2, p37
MaleMale FemaleFemale
Perineal BodyPerineal Body
PerineumPerineum
Urogenital triangleUrogenital triangle
Unit 2, p35Unit 2, p35
Urogenital (UG) TriangleUrogenital (UG) Triangle- Subdivided into 2 Parallel Planes -- Subdivided into 2 Parallel Planes -
•• Deep perineal Deep perineal ““spacespace””
(also called superior perineal pouch) (also called superior perineal pouch)
•• Superficial perineal Superficial perineal ““spacespace””
(also called inferior perineal pouch) (also called inferior perineal pouch)
Deep (superior) spaceDeep (superior) space
Superficial (inferior) spaceSuperficial (inferior) space
•• Filled by 2 muscles and their superior andFilled by 2 muscles and their superior and
inferior fasciaeinferior fasciae
•• Deep transverse perineus muscleDeep transverse perineus muscle
•• Sphincter urethrae muscleSphincter urethrae muscle
Deep Perineal SpaceDeep Perineal Space- Contents -- Contents -
Deep (superior) spaceDeep (superior) space
Deep Perineal SpaceDeep Perineal Space- Boundaries -- Boundaries -
•• Superior: Superior fascial layer of the UGSuperior: Superior fascial layer of the UG
diaphragmdiaphragm
•• Inferior: Inferior fascial layer of the UGInferior: Inferior fascial layer of the UG
diaphragmdiaphragm
•• Anterior: Pubic symphysisAnterior: Pubic symphysis
•• Lateral: Ischiopubic (conjoined) ramiLateral: Ischiopubic (conjoined) rami
•• Posterior: Closed (fasciae are fused)Posterior: Closed (fasciae are fused)
Deep (superior) spaceDeep (superior) space
•• Filled by erectile tissue and their overlyingFilled by erectile tissue and their overlying
musclesmuscles
•• Cavernous and bulbous erectile tissueCavernous and bulbous erectile tissue
•• Ischiocavernosus and bulbospongiosusIschiocavernosus and bulbospongiosus
muscles, respectivelymuscles, respectively
Superficial Perineal SpaceSuperficial Perineal Space- Contents -- Contents -
Superficial (inferior) spaceSuperficial (inferior) space
Superficial Perineal SpaceSuperficial Perineal Space- Boundaries -- Boundaries -
•• Superior: Inferior fascial layer of theSuperior: Inferior fascial layer of the
UG diaphragmUG diaphragm
•• Inferior: CollesInferior: Colles’’ fascia fascia
•• Anterior: Pubic symphysisAnterior: Pubic symphysis
•• Lateral: Ischiopubic (conjoined ramiLateral: Ischiopubic (conjoined rami
•• Posterior: Closed; Fused to the UGPosterior: Closed; Fused to the UG
diaphragmdiaphragm
Superficial (inferior) spaceSuperficial (inferior) space
Deep Perineal Deep Perineal ““SpaceSpace””
Superficial Perineal Superficial Perineal ““SpaceSpace”” (SPS) (SPS)
Superior (the pelvic diaphragm)Superior (the pelvic diaphragm)
Inferior (the skin of the perineum)Inferior (the skin of the perineum)
Superior Fascia of the UG DiaphragmSuperior Fascia of the UG Diaphragm
Inferior Fascia of the UG DiaphragmInferior Fascia of the UG Diaphragm
(Colles(Colles’’ Fascia; Contiguous with Scarpa Fascia; Contiguous with Scarpa’’s Fascia)s Fascia)
Inferior Fascia of the SPSInferior Fascia of the SPS
Anterior Abdominal WallAnterior Abdominal Wall- Superficial Fascia -- Superficial Fascia -
•• Superficial layerSuperficial layer
•• Fatty = Camper's fasciaFatty = Camper's fascia
•• Deep layerDeep layer
•• Membranous = Scarpa's fasciaMembranous = Scarpa's fascia
•• Contiguous with the membranousContiguous with the membranous
fascia of the perineum (Collesfascia of the perineum (Colles’’ fascia) fascia)
Clinical Significance of theClinical Significance of the
Superficial Fascial ConnectionsSuperficial Fascial Connections
A Major Cause for theA Major Cause for the
Clinical Significance?Clinical Significance?
StrabismusStrabismus SibilanceSibilance
Perineum (Sagittal Section)Perineum (Sagittal Section)
FemaleFemale MaleMale
OrangeOrange = Deep perineal space = Deep perineal spaceRedRed = Superficial perineal space = Superficial perineal space
U!